Hospital Treatment and Care By G. Howe. London: Kingsley Publishers. 1999. 160 pp. £11.95 (pb). ISBN: 1-85302-744-8

This book is the third volume in a series addressing different aspects of mental health care and focuses on user experiences of hospital care. Each chapter consists of a case study, followed by a group discussion with 12 service users and carers. The author is the chair of the group.

Obviously the objective of such a book is to draw attention to flaws in the system, but this book is not a long whinge. On the contrary, it is clear that much attention has been given to present both sides of the story. Several negative narratives are balanced by the same person's positive experiences, mostly at a later time in a different setting.

It is difficult to feel a strong sense of identification and discomfort reading the stories, especially because it is all so recognisable. Mostly it concerns the lack of respect, poor communication and poor basic care. What makes it worse is that some follow-up stories show how relatively small shifts in the attitudes of professionals can make colossal differences to patients. We should question whether it is tolerable that some patients are so unhappy with care under the NHS that they are willing to mortgage their houses in order to afford private care. And can we really not provide the same quality of care consistently throughout the NHS? If anything, this book is a strong endorsement of the National Institute for Clinical Excellence and the Commission for Health Improvement.

Of course the book has its weaknesses. The group functions as a Greek choir, often oddly neutralising the impact of the story by their commentary rather than allowing the cases to speak for themselves, too rarely adding personal experiences. The language is also distracting, members being described as survivors and sufferers, and people in the case stories as patients. The introduction and summary are good, highlighting the key issues.

In summary, a book that touched me. No one will agree with every position expressed, but it will be difficult not to agree with the overall message: too many people receive poor care in hospital.